Case Report of Dual-Site Neurostimulation and Chronic Recording of Cortico-Striatal Circuitry in a Patient With Treatment Refractory Obsessive Compulsive Disorder

Abstract

Psychiatric disorders are increasingly understood as dysfunctions of hyper-or hypoconnectivity in distributed brain circuits. A prototypical example is obsessive compulsive disorder (OCD), which has been repeatedly linked to hyper-connectivity of cortico-striatal-thalamo-cortical (CSTC) loops. Deep brain stimulation (DBS) and lesions of CSTC structures have shown promise for treating both OCD and related disorders involving over-expression of automatic/habitual behaviors. Physiologically, we propose that this CSTC hyper-connectivity may be reflected in high synchrony of neural firing between loop structures, which could be measured as coherent oscillations in the local field potential (LFP). Here we report the results from the pilot patient in an Early Feasibility study (https://clinicaltrials.gov/ct2/show/NCT03184454) in which we use the Medtronic Activa PC+ S device to simultaneously record and stimulate in the supplementary motor area (SMA) and ventral capsule/ventral striatum (VC/VS). We hypothesized that frequency-mismatched stimulation should disrupt coherence and reduce compulsive symptoms. The patient reported subjective improvement in OCD symptoms and showed evidence of improved cognitive control with the addition of cortical stimulation, but these changes were not reflected in primary rating scales specific to OCD and depression, or during blinded cortical stimulation. This subjective improvement was

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“…An increase in the parameter α in right SCC was associated with treatment response for SCC DBS for MDD (Veerakumar et al, 2019 ). Subjective improvements of OCD symptoms were associated with increased alpha and beta coherence between the supplementary motor area (SMA) and ventral capsule/ventral striatum (VC/VS) in a patient undergoing VC/VS DBS (Olsen et al, 2020 ). Additionally, an intraoperative case report in OCD identified a ~35 Hz gamma oscillation in the nucleus accumbens that was modulated by patient obsessions (Miller et al, 2019 ).…”